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Miscarriage Risk with Use of Antidepressants During Pregnancy

Although discontinuing use of antidepressant during pregnancy can result in depressive relapse, a new study finds an increased risk of miscarriage in pregnant women using antidepressants.

Antidepressants are widely used in pregnancy and up to 3.7 percent of women will use them at some point during the first trimester.

The study, found in the Canadian Medical Association Journal, found a 68 percent increase in the overall risk of miscarriage in pregnant women using antidepressants.

Most previous studies on the use of antidepressants in pregnancy did not look at miscarriages as a main outcome, had small samples and several showed contradictory results.

This large study sought to determine the association between antidepressant use in pregnancy, including classes, types and doses, and the risk of miscarriage.

Researchers from the University of Montreal and the CHU Ste-Justine looked at data on 5124 women in Quebec from a large population-based cohort of pregnant women who had clinically verified miscarriages up to 20 weeks of gestation and a large sample of women from the same registry who did not have a miscarriage. Of those who miscarried, 284 (5.5 percent) had taken antidepressants during pregnancy.

Selective serotonin reuptake inhibitors (SSRIs), especially paroxetine (Paxil), and an SNRI, venlafaxine (Effexor), were associated with increased risk of miscarriage, as were higher daily doses of either antidepressant.

As well, a combination of different antidepressants doubled the risk of miscarriages.

“These results, which suggest an overall class effect of selective serotonin reuptake inhibitors, are highly robust given the large number of users studied,” writes senior author Dr. Anick BĂ©rard, from the University of Montreal and the director of the research unit on medications and pregnancy at CHU Ste-Justine.

The researchers urge that physicians who have patients of childbearing age taking antidepressants or have pregnant patients who require antidepressant therapy early in pregnancy discuss the risks and benefits with them.

In a related commentary, Ms. Adrienne Einarson, assistant director of the Motherisk Program at The Hospital for Sick Children (SickKids) writes that there is no “gold standard for studying the safety of drugs during pregnancy, because all methods have strengths and limitations,” and results can vary from one study to the next.

In this study, there were missing data on important potential confounding factors. However, the overall results on the use of antidepressants during pregnancy and the risk of miscarriage, despite the different methodology, were almost identical to a Motherisk study with 937 women published in 2009.

“Clearly, this study cannot make any definitive conclusions as to whether antidepressants increase the risk of spontaneous abortion,” although the author points out it appears there is a small risk with less than double the number of miscarriages in the women exposed to antidepressants compared to those not exposed.

Source: Canadian Medical Association Journal

Miscarriage Risk with Use of Antidepressants During Pregnancy

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2015). Miscarriage Risk with Use of Antidepressants During Pregnancy. Psych Central. Retrieved on May 26, 2018, from https://psychcentral.com/news/2010/06/01/miscarriage-risk-with-use-of-antidepressants-during-pregnancy/14203.html

 

Scientifically Reviewed
Last updated: 6 Oct 2015
Last reviewed: By John M. Grohol, Psy.D. on 6 Oct 2015
Published on PsychCentral.com. All rights reserved.